[Adherence to treatment with erythropoiesis stimulating agents]. / Adherencia al tratamiento con agentes estimulantes de la eritropoyesis.

BACKGROUND: To establish adherence to treatment with erythropoiesis stimulating agents (ESA) in patients with anemia associated to chronic kidney disease (CKD), and analyze its relationship to response to ESA. METHODS: Retrospective study of a cohort of 198 patients with CKD who started treatment with epoetin-ß or darbepoetin-a, followed for two years. Basal characteristics, effectiveness (% of hemoglobin (Hb) target attainment, percentage increase of Hb) and adherence (medication possession rate) were registered. A non-adherent patient was one whose mean adherence was <90%. RESULTS: Average global adhesion was 89.6%, slightly higher in treatment with darbepoetin-a than with epoetin-ß; 8.6% of patients were non-adherents. Hb target was accomplished in 87% cases. Level of response to ESA treatment was independent of the degree of adherence to treatment. CONCLUSIONS: Adherence to ESA treatment was good, without differences related to degree of response.

Evaluación de la indicación de los agentes estimulantes de la eritropoyesis en el tratamiento de la anemia asociada a enfermedad renal crónica / Evaluation of the indication of erythropoiesis stimulating agents in the treatment of anaemia associated with chronic kidney disease

OBJETIVOS: Describir las características de los pacientes con anemia asociada a enfermerdad renal crónica (ERC) que inician tratamiento con agentes estimulantes de la eritropoyesis (AEE) y evaluar su indicación. MÉTODOS: Estudio descriptivo transversal. Se incluyeron pacientes ≥ 18 años que iniciaron tratamiento con epoetina beta o darbepoetina alfa entre el 1 de enero 2014 y el 31 de diciembre 2015. Se excluyeron pacientes en tratamiento renal sustitutivo (TRS) y portadores de trasplante renal (TxR) funcionante. Variables estudiadas: sociodemográficas, analíticas, comorbilidades, tratamientos famacológicos concomitantes y relacionadas con la terapia de estudio. Indicación correcta de los AEE: valores de Hb <10,0 g/dL una vez corregida la ferropenia (ferritina < 100 ng/mL e ISAT < 25%). Fuente de datos: Farmatools®; sistema informatizado de historias clínicas. El estudio obtuvo dictamen favorable del Comité Ético de Investigación Clínica de Aragón (CEICA). RESULTADOS: 269 pacientes (59,9% varones, edad media: 74,7±13,2 años), ERC estadio 4 (60,0%). El 64,7% inició tratamiento con darbepoetina α (dosis mediana: 18,7 (4,7-120,0) mig/semanal); el 35,3% con epoetina β (dosis mediana: 6.000,0 (466,7-24.000,0) UI/semanal). Los pacientes tratados con darbepoetina α presentaban estadios de ERC más avanzados (p < 0,001). Aquellos que iniciaron terapia con epoetina β más comorbilidad cardiovascular: insuficiencia cardiaca (IC) (p = 0,002) y cardiopatía isquémica (p = 0,028). El 65,7% presentaba ferropenia y un 37,5% tomaba suplementos con hierro. Hb media basal: 10,2±1,3 g/dL; el 75,8% presentaba niveles medios de Hb < 11,0 g/dL y el 40,8% valores de Hb<10,0 g/dL. CONCLUSIONES: El inicio del tratamiento se ajustó a los parámetros definidos por consensos internacionales

OBJECTIVES: Describe the characteristics of patients with anemia associated with chronic kidney disease (CKD) who start treatment with erythropoiesis-stimulating agents (ESAs) and evaluate their indication. METHODS: Cross-sectional descriptive study. Patients ≥18 years of age who started treatment with epoetin β or darbepoetin α between January 1, 2014 and December 31, 2015 were included. Patients on renal replacement therapy (TRS) and carriers of functioning kidney transplant (TxR) were excluded. Variables studied: sociodemographic, analytical, comorbidities, concomitant drug treatment and related to study therapy. Correct indication of EEE: Hb values <10.0 g / dL after correction of iron deficiency (ferritin <100 ng / mL and ISAT <25%). Data source: Farmatools®; computerized medical record system. The study obtained a favorable opinion from the Ethical Committee for Clinical Research of Aragon (CEICA). RESULTS: 269 patients (59.9% male, mean age: 74.7 ± 13.2 years), stage 4 CKD (60.0%). 64.7% started treatment with darbepoetin α (median dose: 18.7 (4.7-120.0) μg / weekly); 35.3% with epoetin β (median dose: 6,000.0 (466.7-24,000.0) IU / weekly). Patients treated with darbepoetin α had more advanced stages of CKD (p <0.001). Those who started therapy with epoetin β plus cardiovascular comorbidity: heart failure (HF) (p = 0.002) and ischemic heart disease (p = 0.028). 65.7% had iron deficiency and 37.5% took iron supplements. Basal mean Hb: 10.2 ± 1.3 g / dL; 75.8% had mean Hb levels <11.0 g / dL and 40.8% Hb values <10.0 g / dL. CONCLUSIONS: The start of the treatment was adjusted to the parameters defined by international consensus

¿Qué medicamento prescribiría a un paciente con enfermedad celiaca? / What medication should be prescribed to a patient with coeliac disease?

La enfermedad celiaca es una intolerancia permanente a las proteínas del gluten de trigo, centeno, cebada y triticale. El único tratamiento eficaz es una dieta sin gluten durante toda la vida, aunque la adherencia estricta es complicada. Incluso algunos medicamentos contienen almidón como excipiente. La legislación vigente obliga a analizar el contenido en proteínas del almidón de trigo utilizado como excipiente o la ausencia de almidones de otro origen en caso de que se empleen almidones de arroz, maíz o patata. Sin embargo, no especifica que se haga referencia a las trazas de gluten que sean residuos del proceso de producción de los principios activos de los medicamentos. A propósito del caso que se describe, es necesario reflexionar sobre la importancia de informar adecuadamente al paciente y de revisar/actualizar la legislación actual para garantizar el uso seguro de los medicamentos

Coeliac disease is a permanent intolerance to gluten proteins from wheat, rye, barley and triticale. Although strict adherence is complicated, the only effective treatment is a gluten-free diet throughout life. Some drugs contain starch as an excipient, and there is a risk related to the gluten content, which must be avoided in these patients. Current legislation requires the analysis of the protein content of wheat starch, or the absence of starches from another source where rice, maize, or potato starches are used as excipients. But, it does not specify that reference should be made to traces of gluten that are residues of the process of production of the active ingredient. As regards the case described, there needs to be awareness of the importance of adequately informing patients and reviewing/updating current legislation to ensure the safe use of drugs

[What medication should be prescribed to a patient with coeliac disease?] / ¿Qué medicamento prescribiría a un paciente con enfermedad celiaca?

Coeliac disease is a permanent intolerance to gluten proteins from wheat, rye, barley and triticale. Although strict adherence is complicated, the only effective treatment is a gluten-free diet throughout life. Some drugs contain starch as an excipient, and there is a risk related to the gluten content, which must be avoided in these patients. Current legislation requires the analysis of the protein content of wheat starch, or the absence of starches from another source where rice, maize, or potato starches are used as excipients. But, it does not specify that reference should be made to traces of gluten that are residues of the process of production of the active ingredient. As regards the case described, there needs to be awareness of the importance of adequately informing patients and reviewing/updating current legislation to ensure the safe use of drugs.